In this Aug. 19, 2018 photo, track workers repair a section of fence after a wreck during an IndyCar race at Pocono Raceway in Long Pond, Pa. Driver Robert Wickens' car sailed into the fence when he and Ryan Hunter-Reay made contact. Wickens is paralyzed from the chest down.

In this Aug. 19, 2018 photo, track workers repair a section of fence after a wreck during an IndyCar race at Pocono Raceway in Long Pond, Pa. Driver Robert Wickens' car sailed into the fence when he and Ryan Hunter-Reay made contact. Wickens is paralyzed from the chest down. (Matt Slocum / AP)

Wickens, a 29-year-old Canadian driver and member of the Schmidt Peterson Motorsports team, revealed last week on his social media accounts the extent of the injuries he suffered in the crash, saying he is a paraplegic with a T4 injury, paralyzed from his chest down.

“The doctors have told us every SCI [spinal cord injury] is different,” Wickens wrote Oct. 26. “One may walk again and one may not. Each body heals differently. So we can not tell you a definitive answer if I will walk again. But I have full intentions of doing just that.”

The Morning Call talked with neurosurgeon Chris Lycette, co-chief of spine surgery, Lehigh Valley Health Network. Lycette could not speak about Wickens’ condition or treatment but did discuss the basic facts of spinal cord injuries and the team approach taken to provide the most comprehensive care for patients with similar injuries.

Here are excerpts from the interview:

Q: What happens after a spinal cord injury? How or when is the spinal cord considered damaged?

A: It begins with the initial trauma, the arrival of the paramedics and assessing the patient at the scene. Really beginning there, there can be an immediate sense there is a spinal cord injury. If the person is clearly having difficulty moving their arms or legs, that’s a very concerning sign. They get immobilized in the field using what we call “spinal precautions.”

Once the patient arrives at our hospital, at that point there’s a protocol for getting things done rapidly.

It usually starts with a CAT scan because that’s a quick study. That shows spinal alignment and if there are fractures, and gives a good sense of what type of injury may exist.

Usually after that a patient will normally get an MRI, and that shows more anatomical detail.

In worst-case scenarios, we might abort right after the CAT scan and take someone immediately to the operating room if we feel getting them there is going to be the most beneficial option at that point.

Q: Wickens has used the phrase “paraplegic” and said he is paralyzed from the chest down with an incomplete spinal cord injury. What’s the difference between a paraplegic and a quadriplegic?

A: Quad means four so that means it affects all four limbs and para is half. That normally means it’s just the lower part of the body.

Q: And what’s the difference between a complete and incomplete spinal cord injury?

It’s based on a neurological exam. If someone has any function at all below the level of injury [which Wickens does], it’s technically called an incomplete injury. It gives us great hope that with time and therapy there can be improvement. If someone has a complete injury and no sensation and motor function, the chances of getting that back are very grim.

Q: How does a spinal cord injury generally impact body function at that point? Is surgery always necessary?

A: It depends on which level of the spinal cord the injury occurs. The higher up and closer to the brain, the more devastating the injury. Because I think for people that don’t know much about medicine, if you have a spinal cord injury, it’s going to affect everything below it. If you have it in the middle of your back, you will lose leg function as well as bowel and bladder function. If you have an injury higher up in the neck you may also impair your arms and legs, and in the worst case scenario, your breathing.

Q: Is there a likelihood that athletes who suffer from paralysis (or paraplegic injuries) have a higher chance of recovery or the ability to regain movement?

A: I really do think every patient is different. Two people with the same injury may certainly heal differently.

Distributed Photo/Courtesy LVHN

This photo shows Inpatient Rehabilitation Facilities at LVH-Cedar Crest and LVH-Muhlenberg for helping patients with spinal injuries manage pain and return to normal activities. Physical therapy is a crucial component of this process.

This photo shows Inpatient Rehabilitation Facilities at LVH-Cedar Crest and LVH-Muhlenberg for helping patients with spinal injuries manage pain and return to normal activities. Physical therapy is a crucial component of this process. (Distributed Photo/Courtesy LVHN)

Q: What can be done to maximize recovery from a spinal cord injury? Does LVHN have specialized treatments and programs available?

A: I think a couple of things. First of all, it’s getting the surgery done as soon as possible. That really benefits the patient. The next part is the ICU [intensive care unit] care the patient receives. Maintaining blood pressure and oxygenation and very simple things are so, so important for spinal cord injuries. That’s why those patients are in the ICU.

A lot of these patients we see also have multiple injuries. If they’ve had significant injuries, they may need blood transfusions. For example, you wouldn’t want someone to have a low blood count. That’s why intensive care is so critical for these patients, and that’s why you want to be at a premiere trauma center. It’s 24/7. Every single moment counts and the nurses and staff make a huge difference.

It’s critical that the public understands that — it’s a team effort to help these people. It’s the paramedics that got them there. It’s the trauma team that assesses them … the nursing care, the therapists that help these people with the next steps that are all very crucial to recovery.

Q: When these scenarios happen — when an IndyCar driver or anyone comes into the hospital with a severe spinal cord injury, what’s the size of the team that treats them?

A: It’s close to 100 people ... no doubt. When you start adding it all up. In a typical ICU you might have one, two, or maybe three nurses in a 24-hour period. If someone is in the ICU almost two weeks, you can do the math there. The trauma team is a team of eight doctors, and then there’s residents and students.

For us as neurosurgeons, it’s 24 hours a day and we’re constantly handing the baton off. Say there’s six of us and we all took part in the patient’s care. Then there’s the transport team. If a patient has to have an MRI and they can’t move, the transport team has to move the entire bed. Just looking at the entire picture and that care team, it’s really something else.

Q: How can physical therapy and occupational therapy help, and how does LVHN work together with therapists to help patients recover and/or manage complications arising from paralysis?

A: The therapists that are involved have been trained to deal with patients with spinal cord injuries specifically. They’re specialized, and it’s difficult stuff. You can imagine if you can’t move your legs how difficult that is psychologically and physically. They have to address that when they’re working with someone and having them get used to doing basic living things — or what we can activities of daily living. It’s a whole new difficult world.

LVHN has physical therapists and occupational therapists who work together from the time the patient is admitted and cleared for therapy by the physician through inpatient rehab to the time they transition back to the community and are seen in outpatient therapy. Physical therapists typically will work on building the strength of the patient’s legs, improve their balance, and teach them how to walk again and move about in their home and community.

Occupational therapists typically work to improve any weakness or coordination problems the patient may have in their arms. They will also work with improving a patient’s ability to take care of himself/herself. This means they may help them with learning how to bathe themselves, dress themselves, cook, clean and perform other activities of daily living. Physical therapists and occupation therapists work together on helping patients move in bed and transfer from sitting to standing. Therapists can also help determine the most appropriate wheelchair for the patient if needed. Our site at 1243 Cedar Crest has a wheelchair clinic specifically for this. As the individual gets stronger, outpatient physical therapists work on higher level balance and strengthening exercises as well as helping to establish a long-term exercise program for the individual for general fitness and health.

Q: Lehigh Valley Health Network is the “official health care provider of Pocono Raceway.” These athletes use LVHN’s medical staff and resources during their annual NASCAR and IndyCar Series race weekends. What do you want people to know in general if they end up having to come into the hospital and see your team?

A (Lycette): I would say it gets back to this whole team concept. It requires excellence at every level and for everyone to participate with the same high level of care. It’s a commitment of taking care of people. We’re at the front edge of it. We can have days when there might be three or four of these types of injuries and everyone has to be on top of their game. We will do our part and then it transitions to the next phase. But it really requires a team, above all.